Labor Pain-Relief Primer

Understanding Drug Options

Whether you're determined to have a drug-free delivery or want an epidural the moment you feel a twinge, you should understand your drug choices before heading to the hospital. "After all, you can't tell ahead of time how you'll tolerate labor pain," says Frank Witter, M.D., director of labor and delivery at Johns Hopkins Hospital, in Baltimore.

There are two main categories of pain relief -- regional blocks and opioid analgesics. Regional blocks, such as epidurals, spinals, or combined spinal-epidurals (CSE), are injected into your lower back to deliver pain relief right where you need it: your uterus and vagina. They work by stopping pain impulses from traveling up your spinal cord. Opioid analgesics, such as Demerol, are narcotics that are injected into a muscle or run through an IV into a vein. They dull your senses and decrease your brain's ability to perceive pain throughout your body.

According to the American College of Obstetricians and Gynecologists, regional blocks are preferable because they allow the mother to remain more alert and participate in the labor. (Opioid analgesics can cause sleepiness.) However, some obstetricians and midwives choose opioids because they are easier to administer and do not require the services of an anesthesiologist.

The kind of pain relief you're offered may depend on the hospital and region where you are delivering. Doctors at large teaching hospitals tend to keep abreast of the latest pain-relief options, while doctors in small hospitals may use older techniques. Similarly, in big urban hospitals, teams of anesthesiologists are available 24 hours a day, while in rural facilities, laboring women may have to wait for the on-call anesthesiologist to be summoned from home. In the latter case, "a woman may be given an opioid analgesic to tide her over until the anesthesiologist arrives at the hospital," explains David Birnbach, M.D., chair of the American Society of Anesthesiologists' committee on obstetrical anesthesia. "Once it wears off, he can safely administer a regional block." Use our chart to educate yourself; then discuss your options with your doctor. Once labor starts, however, be ready for anything -- and don't judge your delivery on whether or not you took medication. "The real success," Dr. Witter says, "is delivering a beautiful child."

Epidural

How It's Given

A catheter is inserted into the space between the sheath surrounding the spinal cord and the vertebrae of the spine, and a continuous infusion of drugs is delivered, numbing the lower body.

What It Does

Relief begins after about 15 minutes. Alleviates pain in the pelvic area to a varying degree, depending on the concentration of anesthetic.

Things to Consider

Many hospitals still use more traditional epidurals (those with 0.25 percent or more bupivacaine), which can make it difficult to get out of bed and may prolong labor. Newer, more dilute combinations (known as walking epidurals) are less likely to hamper mobility but increase your risk of breakthrough pain. Ask what is available at your hospital.